A blog about home birth, pregnancy, childbirth, motherhood and all that good stuff.
(blog formerly named What Ifs and Fears are Welcome)

Saturday, April 20, 2013

Birth Isn't Medical

My kids
will be able to drive their own cars some day. My husband and I will do our
best to teach them to drive safely and will also have them take a driver's ed
class. In an effort to reiterate how important it is to be a defensive, safe
driver, my husband and I will share some personal stories of losses we have
experienced in our lives due to reckless driving, sadly because we have both
experienced such losses of either dear friend or relative. Are the stories
meant to scare our children? No. They may scare them, true. But they will be
told in our efforts to be completely honest with them as to why we want them to
drive safely and that it’s ok to tell a friend “slow down” or similar if they
are driving with a friend who is driving recklessly.

If the
odds are with them, they will never be involved in a fatal car accident.

Is
driving a car anything like having a baby? No, not really. Not physically or
emotionally. But they both have risks. Many factors in both cases can turn
relatively small risks into very large risks.

I once
read in a forum a simple sentence that spoke volumes to me. When I read it, it
made complete sense to me and it has stuck with me ever since. It was this
simple sentence: Birth isn't medical... until it is.

Birth
isn't an illness. And I don't personally believe it is an accident waiting to
happen. But that doesn't mean an accident can't
happen. If the odds are with a low risk pregnant woman, she'll have an uneventful, safe labor and delivery. But low risk does not mean no risk.

How can we predict when birth will become a medical event? Do we just trust that if someone takes good care of themselves during pregnancy, then all will be well? What about those who do everything "right" during pregnancy and labor but still end up in an emergency situation?

I wanted
to share stories - real life stories - of events when birth became medical, and
in some cases, when it became a down right emergency. It's in those moments - moment when being around professionals who know what to do and how to do it with many
hands and minds to help - that it is very clear that birth isn't medical. Until
it is.

I'm sharing them in an effort to spread awareness. Not to scare you. Information is power. Not just the good, happy information.

All information.

Thank you to all those who shared their stories with me!

****

Christine’s birth of her third daughter:

"Penelope was my third
vaginal birth after a low-risk pregnancy. Labor and delivery was fine, no
complications or issues. It wasn’t until after she was born that we learned
there was a problem. We didn’t even notice it, actually. She looked fine to me.
Our nurse just didn’t think she looked and sounded right so she thought giving
her a little oxygen would help. Quickly, she realized she needed to call a team
in for help – which happened within minutes, maybe seconds. Once they arrived
they very quickly determined that Penelope was having trouble breathing and she
needed to be placed immediately on a ventilator - giving her oxygen was not enough for her. They prepared to move her to a
hospital that was better equipped to take care of her. Before transporting, the
medical team determined she had a diaphragmatic hernia. Basically, there was a
hole in her diaphragm, which restricted her lungs, making it very challenging
for her to breathe without a ventilator until after her surgery. Diaphragmatic
hernias can be much worse. Penelope was lucky in that her defect was small and
she has thrived TREMENDOUSLY! I feel very grateful to have been under the care
of such amazing nurses and doctors in a hospital, where they were able to
immediately save her life and save her from suffering any neurological damage due to her inability to breathe on her own. She is now a happy, healthy toddler!"

Baby Penelope

Anj's birth of her first son:

"Short version is labor
started at 40W6D, he flunked the initial cEFM (continuous electronic fetal monitoring), eventually his heart rate went high with
low variability and he was born emergent c-section after apparently
bleeding out in utero for suspected Vasa Previa. His APGARs were 1 and 8 which
is damned impressive for a baby that was born almost completely flat.

The critical components were continuous electronic fetal monitoring, skilled
team for resuscitation, NICU, Blood Bank for his transfusion soon after birth -
and of course the operating room and OB. My attending was a CNM. She could make the calls, but
obviously not perform the surgery."

Amber's experience as a doula at the birth of
one of her clients:

“This birth was a VBA2C (vaginal
birth after 2 cesarean sections) in a hospital. Picture perfect labor and then
complete placental abruption. The mother was in the operating room under
general anesthesia with baby born in under 4 minutes. OB said that
the abruption had nothing to do with the VBAC.”

Sara's birth of her son:

"I woke up with SROM
(spontaneous rupture of membranes; aka water broke) at 38 weeks and 3 days
after a completely uncomplicated pregnancy. Contractions didn't really start
until around noon; I arrived at the
hospital around 3pm and
was dilated to 9 cm. I had a completely unmedicated birth (not even a heplock),
with intermittent monitoring. My son was born at 5:44pm after a delivery that my CNM described as
"textbook." Then I delivered the placenta and began hemorrhaging.
While my CNM began a manual examination of my uterus, the L&D nurses were
giving me pitocin, cytotec, running an I.V., and paging the attending OB. Within
15 minutes, I was wheeled back to the operating room for repair of a cervical
laceration. I managed to avoid a blood transfusion thanks to prompt care, and
because the OB did an expert job on the repair, I did not have
cervical incompetence during my next pregnancy. I am grateful for
hospital birth and competent providers."

An anonymous OB:

“The thing that always scares the
bejeepers out of me is someone whose labor is just moving along beautifully
with a gorgeous monitor strip and suddenly the fetal heart rate tanks, and you
just can't get it back up. It's the cord. It's pinched, thin, twisted,
prolapsed, or whatever, and it comes seemingly from out of the blue.”

Sarah’s birth of her third child:

“I had a home birth for my third
child. My labor was going along fine if not a little fast. While I was pushing,
my midwife picked up on low heart tones. They were around 50-60 BPM. They
weren't recovering after the contractions. The midwife did not hesitate to say
that we needed to transfer immediately, for that I consider myself very lucky.
It was a forty minute drive to the hospital. I was in the backseat of our van
with my rear end in the air, fighting through the most intense contractions,
praying that the baby would be alive when we arrived at the hospital. When we
got there, the baby's HR had picked back up. I started pushing again, only to
have the HR dip dangerously low again. I headed into the OR for a c-section. It
turns out that he was positioned poorly and the umbilical cord was wrapped
three times around his neck tightly, and very short. His shoulders were also
huge and wide. I believe the nuchal cord saved us from a tragic shoulder dystocia.
There was no way that he was going to come out vaginally. I have had people
tell me that ‘nuchal cords are no big deal, they happen all the time, you just
have to slip it off the head.’ That may be so in some cases, but not always and
not in my case. I am eternally grateful for the hospital staff for safely
delivering my son.”

Desiree’s birth of her first child:

“Normal pregnancy, delivered day
before due date, 7.5 hour unmedicated labor (except one round of abx for GBS),
had mobility, expectant third stage... then, horrible postpartum hemorrhage
requiring two IV uterotonics and internal massage, and left my HGB at a 6.”

Becky’s birth of her second child:

“My first birth was an uncomplicated
vaginal birth. For my second, I was the picture of low risk until my daughter's
cord prolapsed - in the hospital. We had to change floors, but they got her out
in four minutes - including travel time. Her APGARs were 7 and 9.

The scary part is I didn't believe I was in labor, I thought that I was having
Braxton Hicks. My husband and mother forced me to go to the hospital. If I had
been anywhere else- even the hallway- my story would be very different.”

Myrisa’s birth stories of her first two
children:

“For my first baby, I was 30. Low
risk pregnancy. On my due date, my water broke, and my mucus plug fell into the
toilet. Long story short, took 48 hours for me to get to 10 cm and pushed for 3
hours. Baby was beautiful, 9 pounds 5 oz, 21 inches. Then after what seemed
like an eternity, my placenta still would not come. Over an hour later it still
wouldn't come. I started bleeding badly but I did not know, as I was so tired
and groggy. The room filled with people and an anesthesiologist was there
numbing me up from the waist down. I didn't know what was going on and I passed
out. I had post partum hemorrhage because of a retained placenta with accreta
and I nearly lost my uterus. They had to scrape the placenta off the wall of my
uterus since it would not contract; the placenta came out in pieces. They
almost gave me a blood transfusion but instead kept me a couple days extra just
to watch me. It took me a good 2 months to recover completely and to not walk
without a limp.

I viewed that as a bad birth
experience, and I decided on a homebirth with the next baby. I found a CPM. No
complications. Labor day came right on her due date. I tolerated the labor
well; it only lasted 7 hours this time. But when it came to pushing, I was in
the labor tub and I delivered her head, but I could not deliver her body. The
midwife and her assistant hurriedly got me on all fours (Gaskin maneuver) and I
pushed - nothing happened. They rushed me out of the tub and I had to walk to
the bed with the baby's head dangling between my legs. They laid me on the bed
and put my legs up (McRobert's maneuver). After a short while of her seemingly
twisting the baby around, she finally popped out. No cries were heard. I was
getting scared, and I couldn't see her because she was on the bed between my
legs still and they were doing CPR on her. After what seemed to be a looong
time, I finally heard her sputter, then cry. They put her on my chest. I was
just so relieved to see her alive! She was 9 pounds 12 oz, 22.5 inches. I had
no clue what happened, and was just really grateful my baby was ok. Turns out,
as my midwife later told me, she had pretty bad shoulder dystocia and she came
out with meconium. My baby luckily had no birth injury, and is a totally
healthy 3 year old now.”

Karen’s birth of her son:

“I had an unmedicated birth in a
hospital at 41 weeks. It was my second birth and the patterns of contractions
were textbook perfect. I had a great doula. No cEFM just intermittent
monitoring. There was meconium while I pushed. When he was born, his first APGAR
was 5, but it came up to 9 for the second. My husband watched them work on him
and told me later it scared him a little.

When my placenta came out, I noticed
my doctor looking down at it with a worried look. I had retained placenta. And
no epidural. My doctor had to use his hand to remove the rest of the placenta
(thank goodness for my doula!). I knew it had to happen and was a risk of
natural childbirth so I have never felt violated for that action. It was
handled quickly and professionally and I left the hospital with a healthy baby.”

Another anonymous OB:
“I had one of my patients come
into Labor and Delivery b/c she couldn’t remember the last time she felt her
baby move. She was laughing and felt embarrassed and thought she was being over
paranoid. We monitored her and performed an ultrasound. A perfectly
healthy, low risk mom and perfectly healthy little baby… she was 39 weeks
pregnant... Her baby had passed away. It was a cord accident, it was pinched too tightly. It was
heartbreaking. We sat and cried together….

[As far as during labor,] I know two
patients that have had Amniotic Fluid Embolisms. One happened during my
residency and the other actually just happened a few months ago to a woman
under the care of one of my partners. Both women and both babies amazingly
survived. In the case of my partner, we had just had a drill days before it happened to cover this
sort of scenario. It took a lot of hands to get the baby out and to work on the
mother at the same time.”

Melissa’s birth of her first son:

After my first son was born, all
seemed to be OK. It wasn’t until several hours later on after his birth the
nurse noticed an issue when I was trying to nurse him. She thought he was
turning a little blue so she calmly took him back to the nursery for the pediatrician
on call to examine him. His oxygen saturations were not what they should have
been so he was given oxygen. At this point I was so crazy exhausted that I was
slipping in and out of sleep and I remember hearing him crying as they did
various tests to him. Eventually my son was transferred from the small
community hospital I had given birth in to one with a NICU. They did an echo
several days later and diagnosed him as having a heart defect. After that he
was transferred yet again to a hospital where he could get his heart surgeries.
It was quite the introduction into motherhood let me tell you.”

Sarah’s birth and death of their first child:

“I delivered our first child, Kate,
after receiving all of my prenatal care at an independent birth center. Though
I had an uncomplicated pregnancy, as I passed 41 weeks I still hadn’t gone into
labor. I had a biophysical profile ultrasound, which I was told would
indicate if my baby was doing well and if it was OK for me to continue my
pregnancy. The test result was an 8 out of the 8 total potential points
in a biophysical ultrasound, but the test also indicated that my total amniotic
fluid was below the acceptable level. Our midwives told us that it was
acceptable to continue waiting for my body to go into labor.

I went into labor a few days after
I was 42 weeks pregnant and spent nine hours at the birth center in early
labor. The midwives conducted intermittent monitoring of Kate’s heart rate and
started hearing her heart beating irregularly. After an exam, they also
noticed that my amniotic fluid was heavily stained with meconium. I was
transferred from the birth center to a local hospital approximately 6 miles
away.

After being monitored at the
hospital, Kate’s and my vital signs started crashing, so I had an immediate,
emergency C-section. In the operating room, I heard a nurse say that
Kate’s heartbeat was in the 20’s (when normal is over 120). When Kate was
delivered without a heartbeat, doctors resuscitated her, but it took over 10
minutes. In surgery, the doctors discovered that my uterus had
ruptured, greatly complicating the procedure. I had never had any type of
surgery on my uterus before and a uterine rupture on an unscarred uterus is
very rare (possibly in the range of 1:20,000 births).

When I’d recovered sufficiently
from the anesthetic, we went to see Kate in the neonatal intensive care unit
(NICU). As advised by the doctors, we disconnected Kate from life
support. There was nothing anybody could do for her. I held her while she died.
Kate's official cause of death was asphyxia from aspirated meconium; it had
gotten into the alveoli in her lungs and she could not transfer oxygen into her
bloodstream. We don't know if she tried breathing when my uterus ruptured
because it cut off her oxygen supply, or if my placenta had some time earlier
stopped working, or even abrupted (separated from my uterus).

Even if you do everything perfectly and
have no complications you cannot control whether you will have a uterine
rupture, a placental abruption, a hemorrhage, or some other problem that
prevents the flow of blood and oxygen to the baby.

When you are on the rare side of a
statistic (such as the low chance of uterine rupture), the rarity becomes
irrelevant, when the risk becomes reality. If I’d been anywhere other
than the hospital when my uterus ruptured, I, too, most likely would’ve died or
would not have been able to have another child.

Though we can’t know for sure what role my being two-plus weeks overdue played
in Kate’s death, the heavy meconium, which was present long enough to have
stained her fingernails, indicated that she should’ve been delivered much
earlier than when I went into labor.”

4 comments:

I was 38w5d pregnant when my water broke. Our CNM came to our house and began monitoring my contractions about 12 hours later. About 18 hours after my water broke, our CNM noticed signs that things were not progressing normally and transferred me to the hospital.

Upon admission, our son did not have a heartbeat but changing my position brought his heart rate back to normal. I was given an epi and allowed to sleep for a few hours. When I got to 10 cm his heart rate dropped and did not recover. We were rushed into the OR for an emergency c-section. Our son is now a happy, healthy 13 month old, but I shudder to think what would have happened 100 years ago.

I've never understood why people don't understand that babies "breathe" in utero. They breathe in amniotic fluid and whatever else might be covering their nose and mouth (meconium, birth pool water, etc). Just because a functional placenta supplies oxygen via the umbilical cord does NOT mean that baby can't or won't aspirate something that isn't supposed to be in their lungs. Come on people.

Thanks for posting these stories. I am now pregnant with our second baby after an eventful birth with our first. We had a 35 week baby last year due to premature rupture of membranes. We didn't know he was breech until after they started to induce labor at the hospital because I wasn't progressing. I am really glad we decided to give birth at the hospital with the first and they caught the breech positioning before labor really progressed. Our son ended up needing to be rushed to the NICU after his c-section birth and needing a 6 day hospital stay. I was pro all natural child birth in my first pregnancy but after seeing how many unexpected things can occur in pregnancy and delivering I now how a birth plan of healthy mom and healthy baby with the second.